[Atrial fibrillation and thyroid nodules].

Our previous papers reported an association between atrial fibrillation and supracentimeter thyroid nodules. Recently we noticed that the number of patients admitted to our ward presenting this relationship, was higher than average data relating to whole world's population. In this study we tried to prove the existence of this association in a selected group of inpatients aged between 71 and 80.

[Celiac disease and myelodysplastic syndrome. A case report].

Celiac disease is an immune-mediated disorder induced by the intake of gluten proteins involving primarily the gastrointestinal tract. Myelodysplastic syndromes are clonal hematologic disorders, expanded from myeloid stem cells of uncertain pathogenesis. Anaemia is a common finding in patients with celiac disease.

[Pure red cell anaemia secondary to medullary B cell chronic lymphoproliferative disorders. A rare case].

Acquired erythroblastopenia is rather rare, more frequent in adult or old male. In absence of anti EPO antibody, it's associate to inhibition of the erythroid growth mediated by suppressive T lymphocytes, generally T8 or NK or mediated by IgG antibody in association with timoma, lymphoproliferative or immunological disorders, and other diseases. The course usually is chronic and follows that of the associate pathology.

Non-thyroidal illness syndrome and short-term survival in a hospitalised older population.

Background: non-thyroidal illness syndrome (NTIS) has been associated with an adverse clinical outcome.

Objective: to evaluate the prevalence of NTIS, its impact on patients' survival and the possible pathogenic role of systemic inflammation.

Design: observational cross-sectional analysis.

[Low T3 syndrome and left ventricular diastolic function].

Background: Recent data suggest that low triiodothyronine (T3) syndrome may contribute to the pathophysiology of cardiac diseases. Because the development of diastolic dysfunction occurs early in a failing heart, we evaluated whether patients with low T3 syndrome show abnormalities in diastolic function, also in absence of overt cardiovascular disease.

Methods: Thirty-four patients with low T3 syndrome and 34 controls with normal levels of free T3 (FT3) underwent a complete Doppler echocardiographic examination.

[Hypokalemia from ectopic ACTH secretion and hypothiroidism in patient affected by small cell lung cancer].

Endocrin paraneoplastic syndromes are characterized by an ectopic hormonal production. The ectopic adrenocorticotropic hormone (ACTH) secretion is often associated with small cell lung cancer. We report the case of 64-years-old man with persistent hypokalemia in Cushing's syndrome due to ectopic ACTH secretion.

[Abdominal ultrasound features in heart failure].

Heart failure involves many organs and systems. Because of heart failure is one of the most common admission diagnosis in a Medical Ward, we sought their abdominal ultrasound features in addition to the cardiac ones.

[NT-proBNP in elderly inpatients: an useful marker for detecting heart failure?].

In this study we try to determine a cut off for detecting heart failure (HF) with the highest sensitivity and specificity in a population of hospitalized people aged > or = 65 years and to identify potential confounding variables for the interpretation of plasma concentration of the marker. We evaluated 212 consecutive patients admitted to our Department of Medicine, the only inclusion criterion being an age > or = 65 years. We identified a group with clinical and/or instrumental HF, and among remaining patients we selected a normal group without obvious cardiac disease.

[Venous thromboembolism risk in medical inpatients].

Venous thromboembolism is one of the main causes of morbidity and mortality in many diseases, either in medical or in surgical wards. The aim of this study is to determine its frequency in a medical ward and to find all the patients who need a prophylaxys. We examined all the inpatients admitted in our Department during a period of three years, selecting all subjects affected by venous thromboembolism.

Relationship between serum uric acid levels and urinary albumin excretion in patients with heart failure.

Objectives: Hyperuricaemia is a constant finding in patients with heart failure (HF). Upregulated xanthine-oxidase activity seems to contribute to progression of the disease through the production of oxidative stress and the development of vascular and endothelial dysfunction. On this basis we speculated that in HF serum uric acid levels correlated with a reliable marker of endothelial dysfunction as urinary albumin excretion.

[New therapeutic strategies to the advanced non small cell lung cancer].

Lung cancer is an elevated mortality disease in spite of conventional therapy. Today it is possible to identify some molecules, as the epidermal growth factor receptor, involved in the earliest molecular alterations ofcancerogenesis. Here we show the inhibitors of the epidermal growth factor receptor as a therapeutic mean.

[Serum uric acid levels correlate with left ventricular ejection fraction and systolic pulmonary artery pressure in patients with heart failure].

The aim of this study was to elucidate whether in patients with heart failure (HF) serum uric acid (UA) levels correlated with left ventricular ejection fraction (LVEF) and systolic pulmonary artery pressure (SPAP). Fifty consecutive patients with heart failure underwent serum (UA) determination and echocardiographic examination, with measurement of LVEF and SPAP. Twenty healthy age-matched subjects served as controls.

Congenital hypoplasia of the inferior vena cava and inherited thrombophilia: rare associated risk factors for idiopathic deep vein thrombosis. A case report.

In young patients, acquired and genetic causes of deep vein thrombosis frequently interact. The association of congenital hypoplasia of the inferior vena cava with antithrombin III deficiency has never been described in the literature as a causal factor of proximal deep vein thrombosis in young patients. We report the case of an 18-year-old patient affected by deep vein thrombosis due to this rare association without other common risk factors.

[Incidence of thyroid nodules in patients with and without atrial fibrillation].

In one of our previous articles we noted that many patients affected by atrial fibrillation had more thyroid nodules > or = 10mm (38%) than general population (10%). These data are confirmed by a same number of patients without atrial fibrillation admitted to our Department of Internal Medicine. The high incidence of low-T3 syndrome is confirmed too.

[Clinical differences between heart failure versus ischemic patients].

Heart failure represents a very common disease with high mortality, despite therapeutic and preventive measures. In order to evaluate the characteristics of heart failure patients, a case-control study was carried out, comparing sixty heart failure patients versus sixty patients who presented an evident atherosclerotic disease, but not heart failure. Among the differences we found, a higher heart rate, reduced levels of free-triiodothyronine and increased levels of serum uric acid in heart failure patients might directly contribute to its pathophysiology and represent potential therapeutic targets.

Systemic amyloidosis: a clinical challenge.

This study reports a case of an 82-year-old white woman with a history of congestive heart failure refractory to diuretic therapy who was found to have systemic amyloidosis, confirmed by a rectal biopsy. Cardiac involvement by amyloid should be considered in the differential diagnosis of any patient with heart failure with preserved ventricular systolic function, who does not have evidence of ischaemic heart disease or hypertension. However, the rarity of this disease and the various involvement of different organs and tissues are often responsible for missed or delayed diagnosis.

Relationship between low T3 syndrome and NT-proBNP levels in non-cardiac patients.

Objectives: A low T3 syndrome was described in patients with heart failure (HF), and it appears to be associated with adverse outcome, representing an independent predictor of mortality. However, it is not known if low T3 levels contribute to the pathophysiology of HF. On the other hand, it has been seen that an elevation of brain natriuretic peptides (BNP and NT-proBNP) may represent a warning signal for future cardiovascular disease and may be an early marker of diastolic dysfunction.

[Heart failure and cholelithiasis].

We previously found an high incidence of gallstone or cholecystectomy for lithiasis in patients affected by heart failure (52.1% up to 58.6%).

[Atrial fibrillation and thyroid gland].

Many diseases can lead to atrial fibrillation and one of these is thyroid disfunction. The prevalence of atrial fibrillation does not differ between subclinical and overt hyperthyroidism. Hypothyroidism also can be associated to atrial fibrillation.

Amylase: a disease activity index in multiple myeloma?

This study reports a case of a patient with lambda-light chain multiple myeloma who developed a high hyperamylasaemia of the salivary type during the disease and soon afterwards died. Ectopic production of amylase by myeloma cells has been described in a few cases and demonstrated by tissue culture and immunohistochemical techniques. The common characteristics of these cases were: salivary amylase isoenzyme increase, high tumor mass, extensive extra-medullary spread, extensive bone destruction and poor prognosis.

Refractory generalized edema: an infrequent complication of long-term pergolide treatment for Parkinson disease.

Generalized edema is the result of increased interstitial fluid volume due to altered Starling forces or capillary endothelial damage. The authors present a patient with severe Parkinson disease who presented with increasing dyspnea, bilateral pleural effusion, and peripheral edema that was refractory to diuretics. Common causes of the severe loss of fluid into the extravascular space were ruled out and pergolide was suspected.